30 2.6.7 Training Techniques
These skills often require a substantive change in modes of thinking and behaviour. Skills such as empathy, non-judgemental attitude and respect are ways of being and ways of experiencing others rather than concrete skills which can be taught in a classroom setting. Training therefore should focus largely on attaining ideological shifts in GBV understanding as well as enhancing the counsellor’s ability to be self aware and aware of others. GBV and especially IPV are rife with preconceived ideas and many find it difficult to not revert to victim blaming. Therefore a thorough examination and understanding of the complex nature of IPV is important to grasp during the training. Gerdes, Segal, Jackson & Mullins (2011, p. 120) explore methods for training and suggest that “Gestalt techniques, role-playing, and imitative play are methods educators can use to promote affect-based understanding and generate opportunities for perspective-taking insights, self/other- awareness, and emotion regulation”. This form of teaching can also be substantiated with real life examples of IPV cases explained carefully in order to avoid victim blaming and show training counsellors the reality of the situation. The same methods of training can be used to help the counsellor become more self aware and aware of others. Rath (2008, p. 21) found that good training programmes were “also concerned with the personal development of the individual women involved”. Training programmes must take these methods into account in order to achieve desired results.
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discrepancy within the literature regarding the definition of vicarious traumatisation due to the interchangability of these four concepts without a proper understanding of the differences between them. Burnout is defined as the emotional and physical exhaustion and general deterioration experienced when working with people in any profession. This feeling of burnout generally is a result of being overloaded in general as opposed to specifically the result of the traumatised client experiences (Brady & Guy, 1999; Sexton, 1999; Steed & Downing, 1998; Trippany, White-Kress &
Wilcoxon 2004). Vicarious traumatisation encompasses the concept of burnout but is more specific as it refers specifically to the feelings of burnout experienced as a result of working with traumatised individuals and is specifically linked to trauma symptoms (Steed & Downing, 1998;
Trippany et al, 2004). Vicarious trauma is also experienced as a result of the client’s trauma as opposed to secondary factors such as a feeling of being overloaded as defined in burnout. Vicarious traumatisation and countertransference are very similar; however they do hold a significant difference. Countertransference is rooted in psychodynamic theory and refers to the counsellor’s reaction to the client as a result of the counsellors own life experience, emotional processes and defences (Trippany et al, 2004). Vicarious traumatisation is instead a specific reaction to the traumatic experiences of the client. Countertransference is also often only experienced in a session with a specific client, while the effects of vicarious traumatisation transform the counsellor’s cognitive schemas and belief systems to affect every area of the counsellor’s life (Brady &Guy, 1999; Trippany et al, 2004). Compassion fatigue is the most similar to the definition of vicarious traumatisation and is basically defined as “nearly identical to PTSD, except that it applies to those emotionally affected by the trauma of another” and is “related to the cognitive schema of the therapist” (Figley, 2002, p. 3). The reason that vicarious traumatisation is preferred relates more to the wording used rather than the conceptual basis. Compassion implies a way of being and implies that uncompassionate carers are excluded or that it is directly linked to the action of showing compassion rather than as a result of the client’s trauma. The term ‘fatigue’ also implies a physical or mental exhaustion which is more readily identifiable than the often subtle cumulative nature of vicarious traumatisation and not always a symptom for the practitioner. It is clear that the concepts of burnout, countertransference and compassion fatigue do not completely satisfy the definition of vicarious trauma.
Vicarious traumatisation in this research will be defined as the response of those who have been subject to explicit knowledge of, or have had been involved in some form of intervention in a traumatic event (Lerias & Byrne, 2003). This includes any professional or lay person working with trauma survivors. Vicarious traumatisation is a cumulative transformation of the counsellor’s frame of reference, basic assumptions about the world and cognitive schemas (Brady & Guy, 1999;
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Pearlman & MacIan, 1995; Sexton, 1999; Steed & Downing, 1998; Trippany et al, 2004; Williams, Helms & Clemens 2012). The counsellor may experience symptoms of PTSD namely hyperarousal, avoidant or intrusive recollection, and can be diagnosed with PTSD as they meet the Criteria A according to the Diagnostic Statistical Manual IV-TR which states that those who witness or learn about the event may also be affected (APA, 2000; Lerias & Byrne, 2003; Sommer, 2008). Steed and Downing (1998) found that responses ranged from changes in affect such as anger, pain, sadness, shock and distress to physiological effects such as diminished energy levels or sleep disturbances to emotional responses including overwhelming imagery and increased vigilance regarding safety. Vicarious traumatisation not only affects the individual but also how the individual relates to those around them. Counsellors may become emotionally detached or alienated from friends or family as a coping mechanism to deal with the shattering of their basic assumptions.
Intimacy can also become difficult and complicated as counsellors, especially those dealing with IPV, may experience intrusive thoughts of the clients trauma when engaging in intimacy with their own partner (Trippany et al, 2004). The cumulative nature of vicarious trauma is important as Astin (1997) noted that in her own experiences, changes in her cognition and behaviour grew without her notice until one day she realised she had entirely different ideas regarding safety, trusting others as well as self esteem. Lerias and Byrne (2003) confirm this as they found that many who suffer from vicarious traumatisation do not realise they are being affected as they are still able to function relatively well in their daily life.
It is important for counsellors to recognise the onset of symptoms, as the effects of vicarious traumatisation go beyond the personal consequences to have serious professional consequences.
There is a danger that a vicariously traumatised individual will become ineffective and often harmful to the client. (Astin, 1997; Sexton, 1999; Sommer 2008; Trippany et al, 2004). The traumatised counsellor is often no longer able to be fully present to the client due to mental and physical exhaustion resulting in incomplete sessions. The session can become less about the client and more focused on the counsellors feelings of vulnerability, anger and irritability (Trippany, et al, 2004). The disintegration of boundaries is another concern for traumatised counsellors as they struggle to maintain a therapeutic stance and distance, often reverting to the role of ‘rescuer’ as well as engaging in activities outside the counselling interaction (Sexton 1999; Trippany et al, 2004). As the client compels the counsellor to re-evaluate her previously held assumptions, the counsellor has the option to hold onto her world view or alter it to incorporate the experiences of her client. If the counsellor chooses to hold onto her previously held assumptions, she is not able to accept the victim’s reality and often resorts to victim blaming. This is extremely dangerous, especially in a
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counselling situation, as victim blaming results in second injury which is often described as worse than the trauma itself (McFarlane & Van Der Kolk, 1996).
2.7.2 Predictors
The literature is conflicted in examining predictors of vicarious traumatisation. Factors such as gender, age, education, socio-economic status and psychological wellbeing are debated (Lerias &
Byrne, 2003; Williams et al, 2012). A factor that is most commonly agreed upon as a predictor of vicarious traumatisation is the counsellor’s previous exposure to trauma. Sexton (1999) notes that often those who have experienced some form of trauma are drawn to trauma work. While this provides the counsellor with greater insight and sensitivity, it also makes them more vulnerable to vicarious traumatisation (Lerias & Byrne, 2003; Sexton, 1999). Counsellors are at risk of re- experiencing their own trauma as a result of the client’s trauma. Awareness of this vulnerability is crucial as it will help counsellors to be vigilant of their own reactions and be aware of the triggers that might precede these reactions (Williams et al, 2012). A controversial factor in predicting vicarious traumatisation is the appropriate use of empathy. Empathy is an important counselling skill outlined in the literature, which provides a positive counselling experience for the client.
However, by responding with empathy to the client’s situation the counsellor makes herself more vulnerable to experiencing the same emotions as the client (Lerias & Byrne 2003; Williams et al 2012). Taylor and Furlonger (2011, p. 230) note that empathy is “both the vehicle for positive change and also the catalyst for harm for both counsellor and client”. Counsellors attempt to understand the clients experience through the client’s frame of reference while maintaining a consistent sense of self, vicarious traumatisation may occur when the counsellor is not able to maintain this balance (Williams et al, 2012). However, Crumpei and Dafinoiu (2012) found that there is no relationship between empathy and vicarious traumatisation but rather a relationship was found between compassion and vicarious traumatisation. They found that compassion is different to empathy and “this operationalisation separates the cognitive side that refers to the understanding of the patient from the affective side that implies emotional contagion” (Crumpei & Dafinoiu, 2012, p.
441). Therefore those working with trauma clients should be taught to show empathy which requires some level of cognitive understanding and should avoid showing compassion which stems from an emotional affective response in order to reduce vicarious traumatisation.
2.7.3 Prevention and Care
Preventing vicarious traumatisation in counsellors is an important aspect of any organisation working with traumatised clients, as it ensures the psychological and emotional wellbeing of those dealing with the clients as well as the sustainability of the organisation. Kinzel and Nanson (2000) state that many non-profit organisations experience a high turnover rate of volunteers and frequent
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resignation due to negative reactions to client trauma. They argue that implementing strategies that help to minimise the negative impact of trauma work while enhancing personal growth will also benefit the organisation financially as well as foster a positive working environment (Kinzel &
Nanson, 2000; Sexton, 1999).
The first aspect of prevention is information. Providing counsellors with information about vicarious trauma in advance is essential for their psychological well-being (Kinzel & Nanson, 2000;
Sommer, 2008; Trippany et al, 2004). Counsellors must be informed beforehand of the risk, the symptoms they may experience as well as strategies to minimise chances of developing vicarious traumatisation. These individual strategies that minimise possibility of vicarious traumatisation that the literature explores include healthy eating, sleeping and exercise (Steed & Downing, 1998;
Trippany et al, 2004; Williams et al, 2012); ability to identify early warning signs (Lerias & Byrne, 2003; Sexton, 1999); importance of boundaries (Steed & Downing, 1998); spiritual support (Trippany et al, 2004; Brady & Guy, 1999) and a moderate case load (Trippany et al, 2004).
The second aspects of prevention are the support services offered by the organisation.
Trauma organisations must take responsibility for providing support structures that decrease the likelihood of vicarious traumatisation. Establishing an “emotionally supportive, physically safe, and consistently respectful work environment is especially important” as “trauma-related issues heighten intrapersonal and interpersonal stress” (Brady & Guy, 1999, p. 390). A supportive and tolerant work environment will help to ensure that counsellors do not feel ashamed of any symptoms of vicarious traumatisation they may experience and will help to ensure that their feelings and symptoms are made real and legitimate (Sexton, 1999). This can be achieved by having regular time set aside within the organisation schedule to address feelings and concerns and emphasise the importance of community (Brady & Guy, 1999).
A more intimate means of preventing vicarious traumatisation is through some form of supervision or mentoring. The forms of supervision vary and should be structured according to the
“intended purpose of the relationship, the social context and the nature of the relationship between the individuals” but the fundamental feature is a learning relationship with the supervisor and the supervisee (Garvey & Alred, 2003, p. 4). Supervision or mentorship is an important aspect of preventing vicarious traumatisation as it allows a space for counsellors to process their response and facilitate integration of the client’s trauma into their cognitive schema (Cyr & Dowrick, 1991;
Sommer, 2008; Taylor & Furlonger, 2011; Trippany et al, 2004; Williams et al, 2012). It provides an opportunity for the counsellor to receive social support and validation, insight into others coping methods as well as an opportunity to normalise their reactions (Trippany et al, 2004). This
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relationship also makes counsellors accountable to someone else to follow through on self care activities and to ensure that her case load is manageable (Williams et al, 2012). This supervision can be from a more experienced counsellor or a peer but should be controlled by the organisation to ensure that this facility is used (Sexton, 1999). This is often a problem in organisations as supervision is not used due to the counsellor’s desire to be regarded as competent and efficient by her peers and supervisor (Taylor & Furlonger, 2011). This can be countered through a supportive, accepting environment where vicarious traumatisation is not seen as a personal difficulty (Sexton, 1999).